CHAPTER THREE

Changing the frequency, length,

and timing of sessions
Frances Salo

T
his chapter selectively reviews and considers some of the
potentially profound aspects of a change in the temporal
framework of sessions in analysis and psychotherapy. It aims
to explore interventions that many analysts make, sometimes feel that
they are forced to make, and assess any risks and potential benefits.
The dialogue in the analytic space has special features stemming from
the special device of analytic time (Puget, 2009), a time out of time
(Kurtz, 1988, p. 990). When the analyst alters the temporal framework,
with its fixed times, length and number of sessions, it affects the patients
sense of self as a continuity in lived experience through time, through
its reverberations of the patients history. While a number of analysts
have generously shared details of such interventions, for reasons of
confidentiality many have not been named.
The analytic session offers the patient the possibility of becom-
ing conscious of his or her unresolved relationship with time (with
their history and experience, unresolved pre-Oedipal, Oedipal, and
transgenerational conflicts) (Milmaniene, 2009). The set time and
length is an essential part of the frame, and the temporal structure of
the setting allows the different temporalities of the patients internal

65
66 U N U S U A L I N T E RV E N T I O N S

world to become conscious to the patient and the analyst. Containing

and challenging the patient is what underlies the high frequency of
analysis (Rose, 1997). The importance of the temporal framework is far
removed from any implications about the use of time as trivial, as often
explored in literary works. There is extensive literature on psychoana-
lytic perspectives on the sense of time and of timelessness in the uncon-
sciousthe only temporal dimension the unconscious takes is that time
does not pass (Pontalis, 1997). There is similar literature on the part that
time plays in analysis (e.g., Arlow, 1986; Green, 2002; Hartocollis, 1983),
and on the meaning of time within the culture (Akhtar, 1999a, 1999b).
In comparison, detailed literature as relevant to the focus of this chapter
is relatively less; while references to it permeate the clinical literature it
may not have been examined as fully as it might have been.
The mothers care, Winnicott (1961) wrote, enabled the infant to
catch hold of time and research suggests that infants are aware from
birth of rhythm and time. Stern (1985) suggested that the infants sense
of self is constructed out of memories of their affects and histories.
The analysts intervention meets a layering cascade of fantasies and
life experienced. A four-year-old boy patient who was terminating in
analysis told me, Dont think that this place is an airport, meaning
that children are not like aeroplanes running according to a schedule;
a six-year-old girl who had been adopted at two years of age told me,
You have to remember so much harder when you are adopted and
an eleven-year-old boy who had been placed in a childrens home told
me, time disappeared when he could no longer remember his sisters
face from a few months previous. For each of these children, time had
a highly personal significance with which they would respond to any
interventions.
I propose to consider in this chapter the topics of changing the
time, length, frequency and timing of sessions and conclude with ter-
mination of analysis. Consequences of interventions to a previously
agreed-on frequency will be covered but not the arguments underlying
the number of sessions offered per week. When the analyst changes
times, how does the patient hear itis the analyst changing the con-
tract, saying that time and his/her mind is not available? The fre-
quency and duration of sessions may be more context-dependent then
than analysts often acknowledge. The number of sessions per week,
for example, whether it is four or five sessions, may vary according to
 C H A N G I N G T H E F R E Q U E N C Y, L E N G T H , A N D T I M I N G O F S E S S I O N S 67

country, local culture, and the personal circumstances of the analyst. In

considering any changes to the usual temporal frame, it is important to
consider the context of the analysisthe strengths and vulnerabilities
of the patient and the history of their analysis or therapy.

Varying session time

Sometimes sessions are varied for ostensibly practical reasons such
as when an analyst shortens a childs session time by five minutes in
response to a parents request because of a change in the school timeta-
ble. Requests to change times of session, however, whether on the part
of the analyst or patient and whether on a one-off basis or permanent,
inherently face many transference-countertransference difficulties.
Many analysts, if the patient requests a change in the times of sessions
for external reasons that seem reasonable, usually offer such changes
if they can be accommodated within their schedule. Some, however,
do not for various reasons: Laufer (1991, personal communication)
described not always offering a patient a makeup session as this offer
could unhelpfully increase the envy of the analyst perceived as having
an endless cornucopia.
Langs (1989) in his study of patients responses to frame breaks,
stated that every accommodation to a requested frame break was
always followed by associations which suggested that patients viewed
it as measure of the analysts insecurity in the role, an inability to hold
the patient, and perhaps as exploitation, seduction or use of power.
Further study of the patients associations indicated that the analyst
should have refused and kept the frame intact. Langs gave an example
of a patient whose analyst inadvertently kept the patient ten minutes
over the agreed-upon time limit and while subsequent associations
could suggest symbolic material around fear of the fathers castration
Langs, preferring to work in the here-and-now of a communicative
analysis, related it back to the frame break as he felt most patients
wish to revert to the original frame. One question is whether there are
developmental considerations to take into account, for example, when
an adolescent patient is rebellious about an early morning time as he
wants to sleep in. Does occasionally offering a later time when pos-
sible safeguard the analysis in recognition that sometimes the patient
needs to feel that their difficulties have been heard and responded to
68 U N U S U A L I N T E RV E N T I O N S

courteously or is this an enactment? This question will be returned to

in the discussion.
Some analysts have described initiating the offer of another time
when the patient indicates that they are unable to come to a session.
Jacobs (2001) described his taking a corrective initiative on an occasion
when he interpreted that a patient had not asked for a change of time
out of her anxiety about him. Once she had accepted his offer of a time
she could then bring her feeling that he covered up his irritation with
her and he came to agree with her and to feel his offer was an enact-
ment. Similarly, Meissner (2007) described the offer of a substitute time
to a patient had the effect of putting pressure on the patient who had
wanted to skip the hour, but he accepted the time. Meissner thought
that he himself had unconsciously created an authoritarian impasse that
violated the patients autonomy. He considered it was an enactment
and changed his practice to not offer a change of time unless requested
by the patient.
Slightly differently, an analysts offer to let a patient make up the ses-
sions she would otherwise lose if she went on vacation allowed an ana-
lytic dyad a way out of a technical difficulty. Geerkin (2010) described
how her young adult patient, Beatrice, had wanted to take a holiday and
accused the analyst of taking her parents money for sessions that she
did not attend. The offer to make up missed sessions was regarded as
a creative solution, in which the patients parents did not waste their
money, the analyst did not lose her fees, and the young woman could
set off on holiday. This exchange of gifts freed up the situation by
partly satisfyingly the patients demands and it was felt that it allowed
the analysis to continue. Barredo (2010) commented that Geerken had
showed a willingness to give up her need to control the situation and
let herself be surprised by the suggested solution and this allowed her
to find the rhythm and take up her role as analyst again, which ena-
bled forward movement and new topics to emerge.
An analysts change of times or cancellations are likely to be met
by the patient with feelings of being slighted and hurt, and of feeling
special, grateful, and envious. Schwaber (1996) gave an example of
when she made a couple of changes to her schedule that she thought
would be acceptable to her patient; in the next session the patient
was in a confused state, immersed in implicit memories from a time
when she was four years old and her mother had temporarily lost her.
This helpfully brought into the transference the fear of the anger of
 C H A N G I N G T H E F R E Q U E N C Y, L E N G T H , A N D T I M I N G O F S E S S I O N S 69

the mother/analyst and the sense that her time and her possessions
were given to other people.
In another case, a series of cancelled sessions by the analyst led the
patient to feel abandoned by the analyst, and he became covertly venge-
ful towards him, paying his account late and missing sessions (Beattie,
2005). He also developed what appeared to be a near-psychotic thought
disorder. This, however, enabled the idealizing transference and his
guilt to be analysed. Ferro (2005) describes a perhaps relatively inex-
perienced analyst cancelling an appointment and offering to replace it
with a session later in the evening. The patient accepted but felt that
she had to submit, recovered her wish to be more relaxed like her ana-
lyst and then was able to bring in her feared violent and mad split-off
aspects, with material suggestive that she felt her analyst stole from her
and should be tried in court. While on the one hand, Ferro describes
the offer of time as a kind of abuse on the analysts part, it however
initiated material that could be productively used. To sum up, Meissner
(2007) stated that the analyst coming late or interrupting the schedule
can be taken by the patient as their not being invested enough to be
keep their side of the contract and is never positive to or contributory
to the effective work of the analysis. He pointed out that when patients
speak out of a transference context about the analyst neglecting them
with his or her time away from the practice, they may have a point that
the analyst needs to consider. However, it seems that in many of the
examples given the analytic process had continued and perhaps even
been freed up with the changed session time, and this point will be
returned to in the Discussion.

Varying session length

Varying the length of sessions needs first to be set against the cultural
context in which the analyst works. For example, in some countries,
e.g., the United Kingdom, the fifty-minute session is standard, whereas
in others it may customarily be less. It may be forty-five-minutes to fit
in with the analysts timetable or when that is the length of time for
which an insurance company or other agency pays a rebate. The practice
of having no break between sessions produces resentment in patients
who feel that the analyst is preoccupied with managing the transition
and has hostilely deprived them of time (Greenson, 1974). Here I shall
mainly explore the analyst increasing or decreasing the frequency of
70 U N U S U A L I N T E RV E N T I O N S

sessions. Lacan thought that the session should not end routinely but as
a significant act when important material emerged. The interruption
would then acquire the value of an interpretation (Aisenstein, 2010,
p. 463). This technique has been critiqued by many analysts including
Etchegoyen (1991) as carrying a heavy burden of a training through
rewards and punishments (p. 513). The shortened or less frequent ses-
sions of the Lacanian approach will not be discussed in detail here as it
does not seem appropriate to extract this from a whole body of theory,
explicated for example, by Etchegoyen (1991) and Green (2002).
Developmentally, it would be expectable that therapists engaging
in parent-infant or child therapy would work with sessions of variable
length in order to fit in with the needs of the infant or child. With some
child patients, many therapists recognize that at certain times it may be
more therapeutic to finish the session earlier than the standard length.
With a six-year-old boy in analysis, who was referred for a fetish for
stroking womens long hair and dressing up in their clothes, I came to
recognize that a fifty-minute session felt persecuting and I adjusted ses-
sion times closer to a thirty-minute one. Sometimes, with a child who
has become out-of-control in a session, rather than battle on, an analyst
might stop a session early and explain why. At a particular point in
the analysis of a six-year-old patient, he kicked me hard and with the
pain I felt hurt and angry. I decided to stop the session early explaining
that I needed to be able to think and we would meet again the follow-
ing day but not go on seeing each other that day. As Winnicott (1947)
wrote, the analyst needs to be able to hate the patient yet temper his
or her hate.
Some analysts have described that their intervention consists of a
more or less implicit agreement with the patient not to intervene if
the patient needs to end the session say a couple of minutes early out
of extreme anxiety or their need to control. What is critical is that in
time this can be interpreted or the patient comes to understand for
themselves the need to control. In one case, a patient had needed to
change analyst for training purposes and had not fully made the analy-
sis his own. His leaving analytic sessions a couple of minutes early for
a number of years was multidetermined; it functioned as a pocket of
resistance as well as giving the analyst the experience of helplessness.
The analyst interpreted if it seemed appropriate, but chose mainly to
bear in the countertransference the experience that the patient needed
to communicate. Freuds (1913) technique included occasionally
prolonging a session to longer than one hour with less communicative
 C H A N G I N G T H E F R E Q U E N C Y, L E N G T H , A N D T I M I N G O F S E S S I O N S 71

patients, because the best part of an hour is gone before they begin
to open up (pp. 127128). Winnicott thought that sessions with very
regressed patients with borderline personality difficulties needed to be
longer than an hour and variations should tend towards lengthening
the session with perhaps a longer space between sessions (Green, 2002).
A number of analysts have acknowledged briefly extending the session
to give the patient an extra two to five minutes at a time of particular
stress or vulnerability, if the material was important and until a rea-
sonable point of closure was reached. These occasions are mostly not
reported as having negative effects but positive ones. If a patient tries
actively to extend the length of the session, the analyst can either keep
to the frame or extend the time. Extending the time may acknowledge
in a helpful way the patients needs and wishes but also contribute to
countertransference difficulties: analyst and patient may engage in a
transference-countertransference enactment which the patient experi-
ences for example as a seduction.
Kurtz (1988) gives a vignette in which both the time of the session
and its length were altered. He recounted how he went over the end
of the session without realizing it, which resulted in his male patient
bringing material about a car crash he had witnessed as a child. In the
next session, Kurtz suggested they move the patients session to the end
of the day to keep this flexibility possible, for a patient who struggled
against feeling inhibited. The patient was at times able to experience
feelings more fully and gradually this tended to happen more often
and in shorter time spans. In parallel, the handling of the end changed.
I allowed myself to be guided either by my feeling that the natural end
had come or that it would not be reached in the length of time I was
willing to continue. (Natural, here, indicates the achievement of a state
of mutual satisfaction such as that of a symbiotically attuned mother
and infant.) (p. 994). The patient had experienced endings as pain-
ful and asked the analyst to prepare him for them shortly beforehand
and was gradually able to do this himself. Increasingly, sessions ended
within the standard time and he asked for an earlier, more convenient
time. Kurtz, while suggesting that this might be viewed as a special
case, nevertheless, saw this as embodying a universal principle that if
the analyst provides a framework with a beginning and end, the patient
will structure the session in ways that reveal his feelings. Using a flex-
ible hour may or may not be needed but, provided the analysts own time
sense is open, the patient will eventually be able to take clock time into
account without losing its affective measure (pp. 994995).
72 U N U S U A L I N T E RV E N T I O N S

If patients are caught up in intense affect at the end of the session,

they may need a few minutes to compose themselves. This is differ-
ent from the experience of a number of patients who, in the midst of
intense transference feelings, particularly in a regressed state, were
unable to leave the consulting room. While extending the time tends
to lead to countertransference problems, it is sometimes inevitable and
has to be managed. Coltart (1989, personal communication) reported a
dramatic example when a patient refused to leave her analysts living
quarters (above her office) for the best part of a day. Rather than calling
the police, which Coltart knew from the patients part history would
have a negative effect, she chose to allow her to say until her mental
state had improved.
If an analyst runs over time this will also produce reactions to what
may seem a trivial, inadvertent break of routine. Lichtenberg and Slap
(1977) report an occasion when an analyst, who was engrossed in his
efforts to understand a dream related by a young woman late in the
hour, allowed the session to run over by five minutes. This patient, rely-
ing on the analysts integrity, had previously suggested that they spend
an analytic hour in a nearby hotel. That night the patient had a dream
that she was being chased through a subway by delinquents whom she
associated to characters in a novel who had been part of her adolescent
masturbation fantasies. She then recalled the extra few minutes, and
with feeling made the connection between the past sexual fantasies and
her current wishes. Subsequently, she took a more analytically produc-
tive attitude towards her erotic feelings for the analyst.
While an analysts lateness for a session is not a planned interven-
tion, there are a number of recorded occasions of an analyst being a
few minutes late for a session and the patients extreme sensitivity to
thisin one case with an analyst who took five seconds longer than
usual to answer the doorbell. When an analyst has been say, five min-
utes late, the analysts offer to make it up at the end may well be heard
not only as fair but also as the analysts exercise of power in a situation
where they are felt to be indifferent to the patient, and as such pulls
material into the sessions.

Varying frequency of sessions

From a North American perspective, Meissner (2007) reported that
many analysts find reducing slightly in frequency to enable patients
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to continue in treatment until they could resume a four-times-a-week

schedule does not seem to make much difference. From a similar per-
spective, Ehrlich (2010) discussed a case when the patient presented with
financial difficulties, and the analyst considering reducing to a lesser
frequency could have resulted from the analyst not being able to fully
keep the patients analysis in mind. The increase from three- or four-
times-a-week intensity to five-times-a-week is usually noted to make a
difference, mainly in intensification of the transference. Interruptions in
sessions because of the analysts pregnancy have been reported as hav-
ing a productive effect in enabling the patient to work through related
difficulties (Reenkola, 2010). Respecting the patients judgment about
their needs and requests to vary the frequency of sessions is sometimes
thought to be paramount. Puget (2009) described how some patients
request therapy with her after having had analyses with other analysts
and feel that they want to concentrate on what is happening for them in
the present rather than on the past; she came to feel that it was appro-
priate for the analyst to actively accept this.
The analysts thoughtful response to the presence of absence is
called for when the patient does not attend for what may be quite some
considerable time but there seems to be an analytic process underway.
Symington (personal communication) described a patient who had pre-
viously been in analysis with another colleague and, after starting anal-
ysis with Symington, wanted to reduce the frequency of the sessions.
He agreed, feeling that it was important for her to develop a sense of
autonomy of her self. The patient continued to reduce the frequency of
her sessions to about once a month and then gradually was able to ask
for them to be increased back to the initial frequency. Symington felt
that this had had a therapeutic outcome. Similarly, an analytic thera-
pist described a patient with borderline personality difficulties who, at
a time when the patient was extremely fragile, was mildly abusive with
her on the phone and then did not attend for three weeks. The therapist
was able to keep sessions available, knowing that this was a pattern in
the past and aware that not all therapists are in a position to do this
if there are financial constraints or perhaps are less experienced. Two
analysts described patients not attending for several months although in
each case the analyst kept their sessions for them and felt that there was
an analytic process of some kind in place. In one case a cheque for pay-
ment of sessions was posted to the analyst at the end of each month for
three months without the patient having attended sessions. When the
74 U N U S U A L I N T E RV E N T I O N S

patients returned to analysis, they felt that it was important to have

been allowed to complete this experience, and their analyst concurred.
Several analysts have found that for patients in a relatively severe
regressed state, for example, a neurotic patient during a period of
intense infantile transference neurosis or in patients with borderline
personality difficulties, separation from the analyst can result in disori-
entation and other difficulties. A psychiatrist described in supervision a
very deprived patient with whom she had been working for a number
of years and would increase the number of sessions at times of need. She
commented, We often meet four times a week before a break, up from
once or twice a week, and I dont know where I stand. This apparently
not-knowing state belied the fact that this seemed appropriate for this
patient at this point when she had allowed herself to become more vul-
nerable and dependent on her analytic therapist. With the increase of
sessions, this patient opened up in following sessions and brought new
material from an early level. Greenson (1967) felt that it may be neces-
sary to see such patients during a weekend or to have telephone contact
with them and that sometimes knowing the analysts whereabouts made
it unnecessary to arrange for a substitute to replace him. (Greenson also
noted the technical aspect of countertransference responses in those
analysts who seem compelled to work on Sundays.) He thought that
the question of who is leaving whom can be an important technical
point with very sick patients and to spare such a patient the feeling of
acute abandonment, he often found it advisable to allow them to leave
for a brief holiday a day or so earlier than he did. Differently, with a
patient who in intensive sessions began to decompensate, Spero (1993)
suggested that they discontinued the analysis as such but continued on
a session-to-session basis until the patient could follow the schedule.
Attempts to acquire more of the analysts time through extra-analytic
contacts have changed with increased technological developments, with
requests for telephone calls, emails, or getting the analyst to respond to
a text message via mobile phone (an SMS) that the patient has sent, par-
ticularly outside the time of their session if they have not attended or to
prompt them in advance to come to a session (Stone, 2009).
Sometimes an analytic therapist feels that it is necessary to make an
extra-analytic contact to keep the patient alive. Nathan (2010) described
a dramatic intervention in a psychotherapy case. I made a sudden
and unannounced emergency intervention into the life of the suicidal
patient . At the time I felt I had contravened the psychoanalytic
canons of practice. However, I could no longer bear the anxiety, the
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fear that my patient could kill herself and place her children at risk.
The intensity of the anxiety, amongst other analytic considerations, I
believed was diagnostic of an imminent suicide . The work demands
at times that one must be prepared to be able not to bear uncertainty
in the face of imminent death or injury or abuse (p. 12). She therefore
arranged extra contact with the patient and her family. Akhtar (1999a,
1999b), in support of a flexible approach wrote that, If the analyst can
manage to have both flexibility of perspective and a tempered yet deep
regard for the spirit over the letter of the analytic rules and guidelines,
he will be able to come up with what is technically needed (p. 147).

Varying session timing

This section, which awaits fuller discussion, refers only to how thera-
pists might cluster sessions in unusual ways, or with long and/or irreg-
ular gaps between consultations or moving sessions to a particular time
of the day. While most analysts might prefer to give each patient the
same time every day or to have psychotherapy sessions on consecutive
days rather than spread out throughout the week, to maximize their
effect, other analysts actively consider that in varying the times, differ-
ent aspects of the personality can be seen as people do not function the
same way at different times of the day (Etchegoyen, 1991). Winnicott is
well known for seeing patients with long and/or irregular gaps between
consultations when patients had to travel long distances to see him or
during World War II when the regularity of consultations was inter-
rupted. As noted before, he thought that with some patients, sessions
should tend towards being longer with perhaps a longer space between
them. Currently, when a patient has to travel long distances for their
analysis, sometimes between countries, the practice of shuttle analysis
and concentrated analysis has developed to assist in such cases. Here
the temporal framework has changed massively. Qualitative research
with such analysands suggests, nevertheless, that the motivation on
their part is so strong that it can compensate for the disadvantages of
this arrangement (Etchegoyen, 1991; Szonyi & Stajner-Popovic, 2008).

Termination varied or decided by the analyst

Here those terminations which are either varied or imposed by the ana-
lyst are referred to, rather than mutually agreed upon terminations. In
analytic training, it used to be taught that the prospect of termination
76 U N U S U A L I N T E RV E N T I O N S

would ideally arise about the same time in the mind of the patient and
in the analyst, or at least would be initiated by the patient and that
the analyst does not usually set a termination date alone. Green (2002)
thought, however, that it is more likely to be the analyst who, several
years after the start of the analysis, feels like raising the question of
termination with the patient who is by then well into the timelessness
of the analysis. One analyst described how after eight years of analysis,
when the patient did not consciously have the idea of terminating in
her mind, he was prompted in response to an intuition about the mate-
rial to suggest a termination date two years ahead, which seemed ben-
eficial in the analytic process. Some patients need at times to increase
the frequency, while others need to reduce the frequency to face the
reality of the separation (Firestein, 1969); other analysts describe sit-
ting the patient up, before reducing frequency and duration of sessions
analysis.
Much recent literature on termination has focused on interruptions,
impasses and re-analyses (Kogan, 2010). When the analyst responds
to an analytic impasse with an ultimatum about the need to either work
analytically or to terminate, this may propel the patient to be able to
move through a potentially destructive phase and resume analytic work.
Initiating termination is a parameter of treatment, which analysts may
resort to, in order to counteract the effects of timelessness when those
effects have become undesirable, counterproductive, or self-defeating
(Hartocollis, 2003, p. 949). But Freuds (1918) setting a time limit in the
Wolf mans analysis can be viewed as a forced termination and con-
siderable negative potential traced (Novick, 1997).
Analytic interventions that attempt to move the process of termina-
tion out of an impasse may be further tailored for the individual patient.
Meissner (2007) describes how with a patient whose analysis he had
assessed as stalling, he suggested reducing the frequency from five to
four hours a week to lessen the attachment to him (although he did
not initiate setting a termination date). The patient, after expressing his
hurt and anger, quickly came to a resigned acceptance and continued
the four-hours-a-week schedule for the remaining four years of analysis
but with continued reverberations about missing the closer contact of
the five-hour schedule. One analyst described an inhibited patient in
analysis for many years who was reluctant to terminate. In an attempt
to get beyond a strong resistance and drawing on Ferenczis idea of
raising the clinical temperature in the analysis of the regressed patient
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to come closer to the resisted affect, the analyst suggested that she
might scream. While the patient was cross at the ending, she knew that
even if another year was offered, she would still have to face at some
point how impossible she found it to end. Initiating the termination
process may convey to the patient that the analyst has processed guilt
about the analysis ending and is relatively satisfied with what has been
achieved. To scream meant the patient could experience her emotional
pain about loss rather than defending herself from it and could end the
analysis with sadness. In a continual dialectic between a more classical
technique and the view that it is important for the analyst to retain their
flexibility, views about practice proliferate. While some patients have
difficulty committing to the undefined period required for analysis, two
analysts recently acknowledged as though their stance was unusual
and not quite correct, their active acceptance of a time limit imposed at
the outset by the patient who said that because of a pre-arranged work
posting they would only reside for two years in the town where the
analyst practiced. In both cases the analysts felt that an analysis under
those conditions worked well.
Most analysts tell their patients that they will see them after termina-
tion if they need further help. One analytic therapist described a situ-
ation where her ex-patient requested a further two sessions because
her mother had died; the therapist agreed and offered twelve sessions.
The therapist then described feeling in a panic that this would not be
enough time to process the mothers death and discussed in supervi-
sion whether she should continue to work with her ex-patient or refer
on to another therapist. It seemed important in this case to do the latter,
as the patient knew that the therapist had partially retired. As clinical
observations of analyst-initiated post-termination contacts suggest that
these are not damaging but usually consolidate gains, facilitate self-
analytic function and posttermination mourning (Schachter & Johan,
1989), recommended that in the termination phase, the analyst offers
a single face-to-face extra-termination contact within the year to assess
gains (and help the patient achieve further help if needed), and only at
the patients request. Women analysts were more likely to have post-
termination contact with their analysands than men analysts, and this
gender difference needs further elucidation.
Finally, some patients may need intermittent analysis. Green (2002)
suggests that although there are analyses that seem to end well,
often additional analyses are necessary before it is possible to finish
78 U N U S U A L I N T E RV E N T I O N S

definitively. He thought that when there are resistances which may

prove insurmountable and play a useful role in the subjects equilib-
rium, it is probably wiser to free the patient and to suspend the ana-
lytic process, while waiting until circumstances create the need to take
it up again. This is only appropriate with patients when the analyst
does not feel that terminating is likely to have damaging effects, seri-
ously compromising future prospects or health. In such cases the ana-
lyst would show, but without applying pressure, that s/he disagrees
with the patients wish to end the analysis. Green thought that an analy-
sis extending over different time periods is more likely to bring about
structural changes than a single analysis in an intense rhythm of five
times a week. He therefore thought that the analyst, while remaining
open to the possibility of psychic movement at a later stage, needs to be
able to accede if the patient wants to terminate (or interrupt), and if this
is achieved in a good-enough way it may facilitate the patient having
more analysis.

Discussion
As Meissner (2007) put it succinctly, manipulations of the analytic
schedule, even for the best of reasons, cannot be done without cost:
requests on the part of either analyst or patient to change times of ses-
sion, whether on a one-off basis or permanently, inherently face poten-
tial transference-countertransference difficulties. A temporal variation
alters the framework of treatment and therefore changes the analytic
situation. A number of the instances may be viewed as amounting to
enactments along a spectrum. They raise questions about why analysts
vary their technique. What is the extent of analytic disclosure about this
and has it been relatively guarded?
Handling patient requests for modification of the frame has been
taken as evidence at least in part of the patients anxiety and conflicts,
and correspondingly the analysts inclination to initiate changes to the
external frame should at least be considered a signal of the analysts
fears and a possible enactment of conflict or trauma (Ehrlich, 2010).
Ehrlich found, however, that when making the offer to increase sessions
patients became more engaged and hopeful, and the work deepened.
A main point discussed here is whether temporal variations are to be
viewed as a breach of the setting or are rather to be regarded as analyst
and analytic situation having a flexible frame (or both)? Do changes
 C H A N G I N G T H E F R E Q U E N C Y, L E N G T H , A N D T I M I N G O F S E S S I O N S 79

in the setting imply, as many analysts suggest, a moving away from

rigorous psychoanalytic practice, defined as aiming to elicit transfer-
ence (Aisenstein & Smadja, 2010)? Or, as Ferenczi argued, is it a move
away from rigidity to an independent stance of occasionally encour-
aging the patient to do certain things, i.e., as an analyst who takes an
active stance but without actually making suggestions to the patient.
Kurtz (1988) discussed two views of time exemplified particularly by
two major schools, the classic analytic, in which the patients behav-
iour is understood as resistance to be interpreted, whereas in the self
psychology approach the infantile developmental needs are viewed as
having been revived and therefore need appropriate handling to be met
sufficiently for growth to proceed. Making exceptions to the temporal
framework of sessions would then follow from the second approach.
Thus Kurtzs offering a patient a flexible session at a time of need con-
stitutes a parameter only if the fixed time session is taken as a rule, in
which case the outcome is the only test for the validity of altering it.
Let us turn now to whether the outcome if known seems to be a
therapeutic one. The fantasized meaning of temporal change for both
analyst and patientwhether the analyst initiates the interventions
(or co-creates them)affects the patient with ongoing reverberating
resonances in the transference-countertransference and intersubjec-
tively. Currently, there is considerable support for the view that this
co-creation may be the only way that the patient can bring material that
is beyond words. Many analysts have the experience that some tem-
poral enactments when they, for example, misread the clock and finish
the session a few minutes early or late or make a mistake about ses-
sion times, have the effect of helpfully bringing into the session mate-
rial about a parent who was felt not to be caring enough to be in touch
with the childs needs. This seems more to do with enactment rather
than acting out (Etchegoyen, 1991). What appears to be a transference-
countertransference stalemate is often the heart of the analytic work
and if this is what precipitates the intervention may be very informa-
tive. Many transference-countertransference difficulties prove fruitful
for the work proceeding. The patients response is the key factor and if
there is a therapeutic outcome this suggests that the patients fantasies
have a more benign outcome. One may think here of Winnicotts (1971)
concept of the necessity for the infant to feel that the object, the mother,
survives the infants aggression and the corresponding importance
for the patient to feel, if the frame is changed, that the analysts mind
80 U N U S U A L I N T E RV E N T I O N S

survives. An intervention by the analyst to the temporal framework as

an object in the transference relationship may feel to the patient to be an
individually tailored intervention and therefore to have some similari-
ties with Greens (2002) objectalizing functionthe key issue in devel-
opment of the transforming drive activity by the intervention of the
object in its relation to time. That is, similar to the Independents con-
cept of becoming the analyst that the patient needs.
If we study closely what happens following an intervention to the
temporal frame, the affect storm often quickly releases useful material
to work with. What emerges as a theme is how often an intervention is
reported as helping the material move along, as grist to the mill. View-
ing an enactment as communicative information allows the possibility
for a more nuanced view of a temporal intervention. An intervention
in the temporal framework may help a patient who feels that there was
a failure of the environment in infancy, to feel that he or she has been
heard (Green, 2002).

Conclusion
Psychoanalysis is a deepening of a relationship between two people to
explore the meaning of the patients concerns. Interventions and altera-
tions to the temporal framework have the potential to have considerable
transference-countertransference effects on the relationship, clearly fac-
ing the patient with the time of the Other (Green, 2002). To summa-
rize the chapter: the different interventions to the temporal framework
have been considered in the light of the literature and what analysts
share privately, and in particular the fantasized meaning to analyst and
patient, the layers of resonances in the transference-countertransference
and intersubjectively to begin to assess how often they were judged to
be therapeutic.
 PART II
ALTERATIONS OF THE METHOD